=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780917708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLUMB LINE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2009
-----------------------------------------------------
Last Update Date | 09/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2195 NEW RD
-----------------------------------------------------
City | BURGAW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28425-3143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-624-3937
-----------------------------------------------------
Fax | 910-259-6009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 909
-----------------------------------------------------
City | BURGAW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28425-3143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-624-3937
-----------------------------------------------------
Fax | 910-259-6009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. AMY SAMARA WILLIAMS-MONROE
-----------------------------------------------------
Credential | BACHELORS
-----------------------------------------------------
Telephone | 910-624-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | MHL-071-025
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------